Infants may not be able to speak but their voice is important

Friday 20 October 2017

Every child needs sensitive and responsive care, particularly in the early months and years of life when we know these experiences will lay the foundations for life-long well-being.

Infants identified as being 'at risk' within their birth families, and who enter our care system from birth or in the early months of life, are an increasingly large group of children in Scotland. This group is particularly vulnerable. Infants depend on adults understanding their care needs, being able to interpret their behaviour and provide appropriate and responsive care.

The data

The number of looked after children in Scotland has been steadily increasing, with children under the age of 5 representing the biggest increase. Here's what the stats tell us:

In 2006, 30% of our looked after population was under 5 years old, by 2016/17 this had increased to 38%; with a large proportion of these children aged under one.

From 2006 to 2017 the number of looked after 0-1 year olds has increased by 59%.

48.9% of all Child Protection Orders granted involved a child under two years old.

The increase could be attributed to any number of changes in practice including: services identifying risk during pregnancy; the early intervention, support and assessment of parents; and a developing understanding across children's services of the crucial importance of the antenatal period and first few months of life. A number of serious case reviews have also highlighted the inherent vulnerability of this age group, with 36% of all child deaths in the UK involving a child under 1 year old.

Challenges in meeting the needs of infants

One of the greatest challenges in representing this age group is that they do not have a 'voice' and can so easily be ignored or overlooked.

All too often, we view an infant as belonging to a parent, rather than being an individual in their own right. Infants can become lost in the conflicting priorities of decision makers. A focus on the rights and voices of adults can so easily overshadow those of the infant.

We often think of an infant as simply too young to understand, remember or be harmed by their experiences. This can lead to an infant's perspective being ignored, or not adequately acknowledged, recorded and included in recommendations and decisions about their future.

Understanding the needs of babies

Infants have unique nonverbal ways of expressing themselves and have the same capacity to feel, experience stress and form secure relationships as any other child. From birth, babies communicate by crying, listening and displaying a vast range of facial expressions. Many infants in the care system will have experienced trauma in their early months of life and might exhibit physical distress through disrupted sleep patterns, feeding problems, toileting difficulties, as well as emotional anxiety and distress. All behaviour is communication and we need to pay significantly more attention to the unique ways that infants express themselves and educate parents, caregivers and professionals to recognise and respond to relationship-based attachment behaviours.

As part our PACE (Permanence and Care Excellence) work in Orkney, a well-being baby tool has been used to support parents in understanding their baby's needs. This simple visual tool presents to the parents or carers what the child's needs are by sharing what's required for them to develop i.e. 'I need you to think of me as an individual. I need you to understand how I feel.'

In writing this blog, I typed the words 'infant' and 'baby' into some of our key children's services search engines in Scotland and failed to find anything. I found no information to support an understanding of the needs of infants, or information that might best support practitioners working with them and their families. On each website, an assumption was made that all children have the capacity to participate, have a voice and 'be heard'.

Children's services need to work closely with families to help them understand their child's stage of development, which will have been influenced by their early experiences. Pre-birth assessment is also key. A recent study in England, carried out by Lancaster University, looked at vulnerable birth mothers who have had children repeatedly removed from their care and what can be done to break this negative cycle.

Given the growing population and vulnerability of looked after infants in Scotland, I think we need to consider them with the priority they deserve, as a distinct group with their own needs. Services need to adapt to ensure that all those involved in their life (parents, extended family, carers and professionals) understand their needs, give them the voice they deserve and ensure we get it right from the start.

Linda Davidson is a Permanence Consultant at CELCIS.

Pre-birth support and early assessment is the topic of our PEW (Practice Exchange Workshop) on 30 November 2017. Please see the CELCIS website to register for this event.